REVIEW - Reducing toxicity of MTX with folic acid [and folinic acid = leucovorin]

[Guest guest]

leucovorin = folinic acid

Z Rheumatol. 2005 Jun;64(5):353-8.

[Reducing toxicity of methotrexate with folic acid]

BACKGROUND: Methotrexate is considered to have the best ratio of efficacy to

toxicity of the disease modifying antirheumatic drugs. Recently it has been

shown to enhance the life expectancy of patients with rheumatoid arthritis.

Some 30-60% of RA patients discontinue MTX treatment within 1 year because

of side-effects. In this review, the current data about supplementation with

folate or folinic acid and their effect on the toxicity and efficacy of

low-dose methotrexate therapy are analysed. METHODS: A Medline search was

performed using " folate " , " folic acid " , " folinic acid " , " homocysteine " ,

" methotrexate " , " cardiovascular " , " heart infarction " and " rheumatoid

arthritis " as search terms. The relevant literature was reviewed and other

papers referred to as references were explored.

CONCLUSION: Both folate and folinic acid reduce methotrexate toxicity and

the discontinuation rate, and decrease methotrexate-induced

hyperhomocysteinemia. Folate is less expensive, more secure and easier to

handle than folinic acid. The efficacy of methotrexate probably decreases

slightly, but the benefit outweighs the risk. Folate supplementation should,

therefore, be routinely prescribed to every patient taking low-dose

methotrexate.

PMID: 15965822

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5965822

Not an MD